System and method for holographic image-guided percutaneous endovascular percutaneous procedures

ABSTRACT

Holographic image-guidance can be used to track an interventional device during an endovascular percutaneous procedure. The holographic image guidance can be provided by a head-mounted device by transforming tracking data and vasculature image data to a common coordinate system and creating a holographic display relative to a patient&#39;s vasculature to track the interventional device during the endovascular percutaneous procedure. The holographic display can also include graphics to provide guidance for the physical interventional device as it travels through the patient&#39;s anatomy (e.g., the vasculature).

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.62/487,519, filed Apr. 20, 2017, entitled “3D HOLOGRAPHIC GUIDANCE ANDDEVICE NAVIGATION AUGMENTED TO THE INTERVENTIONAL SITE FOR PERCUTANEOUSPROCEDURES”. This provisional application is hereby incorporated byreference in its entirety for all purposes.

GOVERNMENT FUNDING

This invention was made with government support under HL119810 awardedby the National Institutes of Health. The government has certain rightsin the invention.

TECHNICAL FIELD

The present disclosure relates generally to endovascular percutaneousprocedures and, more specifically, to systems and methods that provideholographic image-guidance for the endovascular percutaneous procedures.

BACKGROUND

Image-guided surgery (IGS), also known as surgical navigation, visuallycorrelates intraoperative anatomy with a preoperative image in real-time(or “live”). Often, IGS is considered to be analogous to global positionsystem (GPS), a technology that permits individuals to show theirrelative position on a computer-generated map. In IGS, the preoperativeimage can serve as the map, and the intraoperative tracking system issimilar to the satellites and devices that are used for GPS. Using IGSprovides greater control of a surgical procedure, real-time feedback onthe effect of the intervention, and reduced trauma/disruption whenaccessing the surgical target.

The theoretical usefulness of IGS is limited in practice due to thevisual correlation of the intraoperative anatomy with the preoperativeimage. Increased use of the intraoperative imaging would lead to greaterconfidence with avoiding critical structures and locating the target,but this leads to an increased radiation dose burden to the patient andthe interventionist due to the real time fluoroscopy or computedtomography (CT). Additionally, images of the target and aninterventional instrument are presently displayed on a flat, 2D monitorat tableside. To control the interventional instrument, theinterventionist must translate its position and trajectory relative tothe target viewed on a 2D monitor into physical trajectory adjustmentsthat are needed to correct the path of the instrument. Currentimage-guidance techniques can lead to procedure related complications(such as hemorrhage). Moreover, the use of CT guidance for percutaneousprocedures can affect revenue for the institution by reducing the numberof diagnostic scans being performed (decreasing throughput).

SUMMARY

The present disclosure relates generally to endovascular percutaneousprocedures and, more specifically, to systems and methods that provideholographic image-guidance for the endovascular percutaneous procedures.

In one aspect, the present disclosure can include a method for providingholographic image-guidance for an endovascular percutaneous procedure.The method can be performed by a head-mounted device that includes aprocessor, which can receive tracking data for a physical interventionaldevice in a tracking coordinate system; transform the tracking data forthe physical interventional device in the tracking coordinate systeminto a headset coordinate system; access image data from a pre-operativeimage of a patient's anatomy comprising a physical operative site in animaging coordinate system; transform the image data in the imagingcoordinate system into the headset coordinate system; register a 3Dholographic representation of the interventional device based on thetracking data for the physical interventional device in the headsetcoordinate system to 3D anatomical holographic projections of thepatient's anatomy based on the imaging data in the headset coordinatesystem; display the 3D anatomical holographic projections providing avisualization of a holographic version of the patient's anatomy withreference graphics related to a physical operative site within thepatient's anatomy; display the 3D holographic representation of theinterventional device providing a visualization of a holographic versionof the interventional device with guidance control graphics related tothe physical interventional device; and navigate the 3D holographicrepresentation of the interventional device in the 3D anatomicalholographic projections based on the tracking data for theinterventional device in the headset coordinate system. The referencegraphics and the guidance control graphics provide guidance for trackingthe physical interventional device through the patient's anatomy usingthe 3D anatomical holographic projections and the 3D holographicrepresentation of the interventional device.

In another aspect, the present disclosure can include a head-mounteddevice to holographic image-guidance for an endovascular percutaneousprocedure. The head-mounted device includes a non-transitory memory thatis accessed by the processor to execute instructions to performoperations. The operations include receiving tracking data for aphysical interventional device in a tracking coordinate system;transforming the tracking data for the physical interventional device inthe tracking coordinate system into a headset coordinate system;accessing image data from a pre-operative image of a patient's anatomycomprising a physical operative site in an imaging coordinate system;transforming the image data in the imaging coordinate system into theheadset coordinate system; registering a 3D holographic representationof the interventional device based on the tracking data for the physicalinterventional device in the headset coordinate system to 3D anatomicalholographic projections of the patient's anatomy based on the imagingdata in the headset coordinate system; displaying the 3D anatomicalholographic projections providing a visualization of a holographicversion of the patient's anatomy with reference graphics related to aphysical operative site within the patient's anatomy; displaying the 3Dholographic representation of the interventional device providing avisualization of a holographic version of the interventional device withguidance control graphics related to the physical interventional device;and navigating the 3D holographic representation of the interventionaldevice in the 3D anatomical holographic projections based on thetracking data for the interventional device in the headset coordinatesystem. The reference graphics and the guidance control graphics provideguidance for tracking the physical interventional device through thepatient's anatomy using the 3D anatomical holographic projections andthe 3D holographic representation of the interventional device.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features of the present disclosure will becomeapparent to those skilled in the art to which the present disclosurerelates upon reading the following description with reference to theaccompanying drawings, in which:

FIG. 1 is a block diagram illustration showing an example of a systemthat provides holographic image-guidance for endovascular percutaneousprocedures in accordance with an aspect of the present disclosure;

FIG. 2 is a block diagram illustration showing an example of thecoordinate transformation accomplished by the head-mounted device ofFIG. 1;

FIG. 3 is an illustration of an example of a hologram showing referencegraphics and guidance control graphics used to control navigation of aphysical interventional device through a physical vasculature usingholographic image-guidance; and

FIGS. 4 and 5 are process flow diagrams of example methods for providingholographic image-guidance for endovascular percutaneous procedures inaccordance with another aspect of the present disclosure.

DETAILED DESCRIPTION

I. Definitions

Unless otherwise defined, all technical terms used herein have the samemeaning as commonly understood by one of ordinary skill in the art towhich the present disclosure pertains.

In the context of the present disclosure, the singular forms “a,” “an”and “the” can also include the plural forms, unless the context clearlyindicates otherwise.

As used herein, the terms “comprises” and/or “comprising” can specifythe presence of stated features, steps, operations, elements, and/orcomponents, but do not preclude the presence or addition of one or moreother features, steps, operations, elements, components, and/or groups.

As used herein, the term “and/or” can include any and all combinationsof one or more of the associated listed items.

Additionally, although the terms “first,” “second,” etc. may be usedherein to describe various elements, these elements should not belimited by these terms. These terms are only used to distinguish oneelement from another. Thus, a “first” element discussed below could alsobe termed a “second” element without departing from the teachings of thepresent disclosure. The sequence of operations (or acts/steps) is notlimited to the order presented in the claims or figures unlessspecifically indicated otherwise.

As used herein, the term “percutaneous” refers to something that ismade, done, or effected through the skin.

As used herein, the term “percutaneous medical procedure” refers toaccessing a component (e.g., vein, artery, or the like) of thevasculature through the skin, rather than by using an open approachwhere internal organs or tissues are exposed with the vasculature(typically with a scalpel).

As used herein, the term “endovascular” when used with “percutaneousmedical procedure” refers to a medical procedure performed on a bloodvessel (or the lymphatic system) accessed percutaneously. Examples ofendovascular percutaneous medical procedures can include an aneurismrepair, a stent grafting/placement, a placement of an endovascularprosthesis, a placement of a wire, a catheterization, a filterplacement, an angioplasty, or the like.

As used herein, the term “interventional device” refers to a medicalinstrument used during the vascular percutaneous medical procedure.

As used herein, the term “tracking system” refers to something used toobserve one or more objects undergoing motion and supply a timelyordered sequence of tracking data (e.g., location data, orientationdata, or the like) in a tracking coordinate system for furtherprocessing. As an example, the tracking system can be an electromagnetictracking system that can observe an interventional device equipped witha sensor-coil as the interventional device moves through a patient'svasculature.

As used herein, the term “tracking data” refers to information recordedby the tracking system related to an observation of one or more objectsundergoing motion.

As used herein, the term “tracking coordinate system” refers to a 3DCartesian coordinate system that uses one or more numbers to determinethe position of points or other geometric elements unique to theparticular tracking system. For example, the tracking coordinate systemcan be rotated, scaled, or the like, from a standard 3D Cartesiancoordinate system.

As used herein, the term “head-mounted device” or “headset” refers to adisplay device, configured to be worn on the head, that has one or moredisplay optics (including lenses) in front of one or more eyes. In someinstances, the head-mounted device can also include a non-transitorymemory and a processing unit. An example of a head-mounted device is aMicrosoft HoloLens.

As used herein, the term “headset coordinate system” refers to a 3DCartesian coordinate system that uses one or more numbers to determinethe position of points or other geometric elements unique to theparticular head-mounted device system. For example, the headsetcoordinate system can be rotated, scaled, or the like, from a standard3D Cartesian coordinate system.

As used herein, the term “imaging system” refers to something thatcreates a visual representation of the interior of a patient's body(including the vasculature). In some instances, the imaging system canbe 3D. For example, the imaging system can be a computed tomography (CT)system, a magnetic resonance imaging (MRI) system, an ultrasound (US)system, or the like.

As used herein, the term “image data” refers to information recorded in3D by the imaging system related to an observation of the interior ofthe patient's body (including the vasculature). For example, the imagedata can include tomographic images represented by data formattedaccording to the Digital Imaging and Communications in Medicine (DICOM)standard (referred to as DICOM data herein).

As used herein, the term “imaging coordinate system” refers to a 3DCartesian coordinate system that uses one or more numbers to determinethe position of points or other geometric elements unique to theparticular imaging system. For example, the imaging coordinate systemcan be rotated, scaled, or the like, from a standard 3D Cartesiancoordinate system.

As used herein, the term “hologram”, “holographic projection”, or“holographic representation” refers to a computer-generated imageprojected to a lens of a headset. Generally, a hologram can be generatedsynthetically (in an augmented reality (AR)) and is not related tophysical reality.

As used herein, the term “physical” refers to something real. Somethingthat is physical is not holographic (or not computer-generated).

As used herein, the term “two-dimensional” or “2D” refers to somethingrepresented in two physical dimensions.

As used herein, the term “three-dimensional” or “3D” refers to somethingrepresented in three physical dimensions. An element that is “4D” (e.g.,3D plus a time and/or motion dimension) would be encompassed by thedefinition of three-dimensional or 3D.

As used herein, the term “reference graphics” refers to a holographicimage related to a physical operative site within the patient's anatomyto aid in guidance of an interventional device.

As used herein, the term “guidance control graphics” refers to aholographic image related to an interventional device to aid in guidanceof the interventional device.

As used herein, the term “integrated” can refer to two things beinglinked or coordinated. For example, a coil-sensor can be integrated withan interventional device.

As used herein, the term “degrees-of-freedom” refers to a number ofindependently variable factors. For example, a tracking system can havesix degrees-of-freedom—a 3D point and 3 dimensions of rotation.

As used herein, the term “real-time” refers to the actual time duringwhich a process or event occurs. In other words, a real-time event isdone live (within milliseconds so that results are available immediatelyas feedback). For example, a real-time event can be represented within100 milliseconds of the event occurring

As used herein, the terms “subject” and “patient” can be usedinterchangeably and refer to any vertebrate organism.

II. Overview

The present disclosure relates generally to endovascular percutaneousprocedures and, more specifically, to systems and methods that provideholographic image-guidance for the endovascular percutaneous procedures.The holographic image-guidance allows for real time navigation of aphysical interventional device through a patient's vasculature to aninterventional target. Tracking data (position and orientation) for thephysical interventional device can captured using a tracking system tonavigate the physical interventional device through the patient'svasculature. A 3D holographic interventional device can be projectedwithin a 3D holographic anatomical image that is generated based onpre-operative images and navigated based on the tracking data. The 3Dholographic interventional device can be displayed within the 3Dholographic anatomical image due to the tracking data and the image dataeach being transformed into a coordinate system of a headset thatdisplays the 3D holographic images.

Such holographic image-guidance is achieved using augmented reality (AR)to display 3D holographic projections at the interventional site inregistration with the physical patient instead of displaying sourceimages on a 2D monitor. The systems and methods of the presentdisclosure help to overcome limitations of traditional image guidedprocedures, which use CT and fluoroscopy. The use of holographicimage-guidance leads to a shorter procedure time with less radiationdose to both the interventionalist and the patient, as well as fewerprocedural complications caused by hitting critical structures duringthe procedure. Moreover, the holographic image-guidance allows forhands-free guidance and navigation that facilitates sterility of thesurgical field. The use of holographic image-guidance can also increaserevenue by allowing percutaneous procedures to be performed outside of ahigh-tech 3D CT suite, using less expensive (lower tech, such as 2D)guidance imaging, such as ultrasound and mobile C-arm fluoroscopy inconjunction with the holographic image-guidance.

III. Systems

One aspect of the present disclosure can include a system 10 (FIG. 1)that provides holographic image-guidance for endovascular percutaneousprocedures. Endovascular percutaneous procedures can refer to anymedical procedure performed on any portion of a subject's vasculature orlymphatic system that is accessed percutaneously (e.g., through thepatient's upper leg or groin area). Examples of endovascularpercutaneous medical procedures can include an aneurism repairprocedure, a stent grafting/placement procedure, a catheterizationprocedure, a filter placement procedure, a wire placement procedure, anendovascular prosthesis placement procedure, an angioplasty procedure, aguidewire placement procedure, a minimally-invasive catheter procedure,an ablation procedure, a cryoablation procedure, or the like.

The holographic image-guidance can use 3D augmented reality to replaceor otherwise enhance traditional 2D image guidance. The system 10 caninclude a head-mounted device 11 that can be configured to facilitatethe 3D augmented reality holographic display. The head-mounted device 11can include a non-transitory memory 13 and a processing unit 12 (thatmay include one or more hardware processors) that can aid in the displayof the holographic display. The head-mounted device can also include acamera to record one or more images, one or more image-generationcomponents to generate/display a visualization of the hologram, and/orother visualization and/or recording elements.

The head-mounted device 11 can be in communication with a trackingsystem 14 to receive tracking data. The tracking system 14 can be anelectromagnetic (EM) tracking system that can track the location andorientation of a physical interventional device. The physicalinterventional device can be integrated with one or more sensor-coils.For a non-rigid device (like many used in endovascular procedures), oneor more sensor-coils can be located at a tip of the physicalinterventional device. However, for a non-rigid device the one or moresensor-coils can be located anywhere along the physical interventionaldevice and need not be on the physical interventional device at all(e.g., may be located outside the patient's body). As the physicalinterventional device traverses a patient's vasculature, the trackingsystem 14 can detect the one or more sensor-coils and provide trackingdata (e.g., with six degrees of freedom) in response to the detection.For example, the tracking data can include real-time 3D position dataand real-time 3D orientation data. The tracking system can also detectcoil-sensors that are not located on the physical interventional device(e.g., located on fiducial markers or other imaging targets). Thetracking data can be recorded in a coordinate system of the trackingsystem 14 and sent (wirelessly and/or via a wired connection) to thehead-mounted device 11.

The head-mounted device 11 can also be in communication with a computingdevice 15 to receive data related to a preoperative imaging study of atleast a portion of the underlying anatomy. The preoperative imagingstudy can record 3D images (e.g., tomographic images) of the portion ofthe patient's anatomy. The 3D images can be represented by imaging data(which can be DICOM data), which can be formatted according to animaging coordinate system of the certain imaging modality that was usedto record the imaging data and sent to the head-mounted device 11.

As shown in FIG. 2, the tracking coordinate system 16 and the imagingcoordinate system 18 can each be transformed (e.g., translated androtated) into the headset coordinate system 17. The transformation canbe based on a rigid body affine transformation, for example.Accordingly, the tracking data in the tracking coordinate system 16 canbe transformed (e.g., translated and rotated) into the headsetcoordinate system 18. Likewise, the imaging data in the imagingcoordinate system 18 can be transformed (e.g., translated and rotated)into the headset coordinate system 18. Only when the tracking data andthe imaging data is each transformed into the headset coordinate systemcan a visualization be generated showing a 3D holographic viewillustrating the navigation of the physical interventional device withinthe patient's vasculature.

FIG. 3 is an image showing visualizations of the holographicimage-guidance. FIG. 3 shows a hologram of a stent being implanted to alocation in the vasculature (e.g., a model of the renal artery). Thehologram includes guidance graphics and annotations showing trackinginformation. However, the guidance can be visual and/or auditoryfeedback related to location and orientation of the physicalinterventional device. The hologram includes guidance graphics andannotations showing tracking information. However, the guidance can bevisual and/or auditory feedback related to location and orientation ofthe physical interventional device. FIG. 3 also shows threenon-collinear fiducial markers 42 that are used for registration. Thefiducial markers 42 can be combination markers so that the positions ofthe fiducial markers 42 can be detected in the tracking coordinatesystem and the headset coordinate system. Additionally, positions of thefiducial markers 42 can be located (e.g., sensor coils on the physicalpatient's skin). The positions of the fiducial markers can be matched tothree or more locations in the image coordinate system.

The head-mounted device 11 can further transform the visualization ofthe holographic image-guidance. For example, the transformation can betranslated, rotated, and/or scaled. The transformed visualization,however, would no longer be precisely aligned with the patient'svasculature.

IV. Methods

Another aspect of the present disclosure can include methods 50, 60(FIGS. 4 and 5) for providing holographic image-guidance for thenon-vascular percutaneous procedures. The methods 50, 60 can be executedby hardware—for example, by the head-mounted device 11 shown in FIG. 1and described above.

The methods 50 and 60 are illustrated as process flow diagrams withflowchart illustrations. For purposes of simplicity, the methods 50 and60 shown and described as being executed serially; however, it is to beunderstood and appreciated that the present disclosure is not limited bythe illustrated order as some steps could occur in different ordersand/or concurrently with other steps shown and described herein.Moreover, not all illustrated aspects may be required to implement themethods 50 and 60. Additionally, one or more elements that implement themethods 50 and 60, such as head-mounted device 11 of FIG. 1, may includea non-transitory memory 13 and one or more processors (processing unit12) that can facilitate the holographic image-guidance.

Referring now to FIG. 4, illustrated is a method 50 for providing andusing the holographic image-guidance. The holographic image-guidance canbe used to guide an interventional device to a target within thevasculature of a patient's body without requiring intraoperative imagingor in addition to intraoperative imaging. The steps of the method 50 canbe performed by the head-mounted device 11 of FIG. 1.

At step 52, 3D anatomical holographic projections of a patient's anatomy(including a portion of the vasculature) can be displayed. Theholographic projections can include reference graphics related to aphysical operative site with a patient's anatomy. At step 54, aholographic representation of a physical interventional device can bedisplayed. The holographic representation can include guidance controlgraphics related to the physical interventional device. At step 56, the3D holographic representation of the interventional device can benavigated through the 3D anatomical holographic projection. Thereference graphics and the guidance control graphics can provideguidance (e.g., visual guidance (pictorial, type, annotation, etc.)and/or auditory guidance) for tracking the physical interventionaldevice through the patient's anatomy using the holographic guidance(using the 3D anatomical holographic projections and the 3D holographicrepresentation of the interventional device). For example, when a line(or graphic) associated with the reference graphics and a line (orgraphic) associated with the guidance control graphics intersect, thephysical interventional device can be in alignment with a trajectorythat would facilitate placement of the physical interventional devicewithin the vasculature. This can be accompanied by a holographicannotation that reports the distance and/or angle deviation from atargeted position or orientation.

The reference graphics and the guidance control graphics can be used toprovide event driven guidance. For example, when a stent is within thepatient's vasculature, the reference graphics and the guidance controlgraphics can provide auditory and/or visual guidance as the stent moves.As the stent is moved through the patient's vascular tree, a beep can beused to indicate proximity to a target location for the stent.Similarly, graphics can provide real-time annotations of the positionand the orientation of the stent and/or showing the intersection withthe target position. In other words, the event driven guidance caninform a user when they are on the right track using one or more eventdriven signals.

The 3D anatomical holographic projections and the 3D holographicrepresentation of the interventional device are expressed in a commoncoordinate system. The 3D anatomical holographic projections are createdbased on image data that is originally in an imaging coordinate system.Similarly, the 3D holographic representation of the interventionaldevice is created based on tracking data that is originally in atracking coordinate system. FIG. 5 shows a method 60 for registering thecoordinates from a tracking system and an imaging system to the commoncoordinate system (the coordinate system used by a head-mounted deviceto generate the holograms). Also included are three non-collinearsensor-coils 42 that are used for registration.

A physical interventional device can be integrated with one or moresensor-coils. For a rigid device, one or more sensor-coils can belocated at a tip of the physical interventional device. However, for anon-rigid device the sensor-coils are distributed to different pointsalong the physical interventional device. As the physical interventionaldevice traverses a patient's vasculature, the tracking system (e.g., anelectromagnetic tracking system) can detect the one or more sensor-coilsand provide tracking data (e.g., with six degrees of freedom) inresponse to the detection. For example, the tracking data can includereal-time 3D position data and real-time 3D orientation data. Thetracking data can be recorded in a coordinate system of the trackingdevice and sent to the head-mounted device. At step 62, tracking datafor a physical interventional device in tracking coordinates can betransformed into a headset coordinate system (by the head-mounteddevice).

A patient can undergo a preoperative imaging study that images at leasta portion of the underlying anatomy. The preoperative imaging studiescan record 3D images (e.g., tomographic images) of the portion of thepatient's anatomy. The 3D images can be represented by imaging data(which can be DICOM data), which can be formatted according to animaging coordinate system of the certain imaging modality that was usedto record the imaging data and sent to the head-mounted device. At step64, image data in imaging coordinates can be transformed to the headsetcoordinate system (by the head-mounted device). 3D anatomicalhierarchical projections generated based on the image data can be basedon one or more surface mesh models, multi-planar reformatted images, orthe like.

At step 66, a visualization can be rendered (by the head-mounted device)using the tracking data in the headset coordinates and the imaging datain the headset coordinates. The hologram can include a 3D anatomicalholographic projection based on the imaging data transformed to theheadset coordinates and a 3D holographic representation of theinterventional device based on the tracking coordinates. As previouslynoted, graphics, including the reference graphics and the guidancecontrol graphics, can provide guidance for tracking the physicalinterventional device through the patient's anatomy using theholographic guidance (using the 3D anatomical holographic projectionsand the 3D holographic representation of the interventional device). Thevisualization can be transformed by translating, rotating, and/orscaling to enhance the navigation. The transforming can be triggered bya physical movement of the head-mounted device (e.g., by tilting thehead in a particular manner).

V. Example Registration Technique

The following description describes an example registration techniquethat can be used to register tracking data (in a tracking coordinatesystem) and imaging data (in an imaging coordinate system) into a commonholographic coordinate system utilized by the head-mounted device thatprovides the holograms. It will be noted that this is a description ofjust a single example and other registration techniques can be usedwithin the scope of this disclosure.

The registration technique transforms the tracking data and the imagingdata into the headset coordinate system. To do so, the head-mounteddevice can perform two affine transformations: EM-to-HL (or trackingsystem to head-mounted device) and U-to-HL (or imaging system tohead-mounted device). In this example, the transformations rely onco-location of image targets (e.g., fiducial markers placed on thepatient's skin and/or anatomical targets) in the different coordinatesystems. Three or more image targets can be used that are non-collinear.For example, at least some the image targets must be visible to thetracking system (requiring a sensor-coil on each of the image targets)and a camera associated with the head-mounted device. In some instances,the same or others of the image targets must be visible to thepre-operative imaging system and the camera associated with the headmounted device.

For the EM to HL transformation, two 3D point sets P_(EM) andP_(H, image target) consisting of corresponding (co-located) point pairsare used: (1) P_(i)(x_(hl), y_(hl), z_(hl)) in HL coordinates locatedwith image targets via the head-mounted device and (2) P_(i)(x_(EM),y_(EM), z_(EM)) localized with EM sensors (physically associated withthe image targets) in EM coordinates for 4 corresponding points. The 3Dpoint sets (P_(EM), P_(H, image target)) are used to determine the EM toHL transformation ([^(EM)M_(HL)]=LSM{P_(EM), P_(H, image target)}) on aprocessing unit associated with the head-mounted device using aleast-square method (LSM). Position and orientation data from the imagetargets (referred to as landmark sensors) and sensor-coils on theinterventional device (P_(EM,lm,i)(t) [^(EM)M_(HL,cal)]=P_(HL,lm,i) (t))are then transformed into HL coordinates using [^(EM)M_(HL)].

With the locations of the landmark sensors and the sensor-coils on theinterventional device tracked in HL coordinates the corresponding 3Dpoint sets in the imaging (U) coordinates for the markers and devicesensors can also be transformed to HL coordinates. For this, the LSMwill also be used to determine a transformation [^(U)M_(HL)(t)], betweenimaging coordinates and HL coordinates ([^(U)M_(HL)]=LSM{P_(U, lm&d,i,),P_(HL,lm,i)}). [^(U)M_(HL)(t)] is then used to transform the imagingcoordinates to HL coordinates. This allows the head-mounted device toproject the holograms on the patient's vasculature (e.g., in thesurgical field).

From the above description, those skilled in the art will perceiveimprovements, changes and modifications. Such improvements, changes andmodifications are within the skill of one in the art and are intended tobe covered by the appended claims. All patents, patent applications, andpublications cited herein are incorporated by reference in theirentirety.

The following is claimed:
 1. A method comprising: receiving, by ahead-mounted device comprising a processor, tracking data for a physicalinterventional device in a tracking coordinate system, wherein thephysical interventional device is used during an endovascularpercutaneous medical procedure; transforming, by the head-mounteddevice, the tracking data for the physical interventional device in thetracking coordinate system into a headset coordinate system; accessing,by the head-mounted device, image data from a pre-operative image of apatient's anatomy comprising a physical operative site in an imagingcoordinate system; transforming, by the head mounted device, the imagedata in the imaging coordinate system into the headset coordinatesystem; registering, by the head-mounted device, a 3D holographicrepresentation of the interventional device based on the tracking datafor the physical interventional device in the headset coordinate systemto 3D anatomical holographic projections of the patient's anatomy basedon the imaging data in the headset coordinate system; displaying, by thehead mounted device, the 3D anatomical holographic projections providinga visualization of a holographic version of the patient's anatomy withreference graphics related to a physical operative site within thepatient's anatomy; displaying, by the head mounted device, the 3Dholographic representation of the interventional device providing avisualization of a holographic version of the interventional device withguidance control graphics related to the physical interventional device;and navigating, by the head mounted device, the 3D holographicrepresentation of the interventional device in the 3D anatomicalholographic projections based on the tracking data for theinterventional device in the headset coordinate system, wherein thereference graphics and the guidance control graphics provide guidancefor tracking the physical interventional device through the patient'sanatomy using the 3D anatomical holographic projections and the 3Dholographic representation of the interventional device.
 2. The methodof claim 1, wherein the physical interventional device comprises anintegrated sensor-coil that is detectable by a tracking system toprovide the tracking data in the tracking coordinate system.
 3. Themethod of claim 2, wherein the tracking data has six-degrees of freedom(6 DOF).
 4. The method of claim 2, wherein the tracking data comprisesreal-time 3D position data and real-time 3D orientation data.
 5. Themethod of claim 2, wherein the sensor coil is located at a tip of thephysical interventional device.
 6. The method of claim 1, wherein theimage data from the pre-operative image of a patient's anatomy isrepresented by patient-specific DICOM image data from one or more 3Dpre-operative tomographic image data sets.
 7. The method of claim 1,wherein the 3D anatomical holographic projections are based on one ormore surface mesh models or multi-planar reformatted images created fromthe image data.
 8. The method of claim 1, further comprisingtransforming, by the head mounted device, the visualization by at leastone of translating, rotating, and scaling to enhance the navigating. 9.The method of claim 8, wherein the transforming is triggered by aphysical movement of the head mounted device.
 10. The method of claim 1,wherein the transforming further comprises: locating positions of threeor more fiducial markers on the physical patient's anatomy, wherein thepositions are in the tracking coordinate system; and matching thepositions of the three or more fiducial markers to three or morelocations in the image data in the image coordinate system.
 11. Themethod of claim 10, wherein the positions of the three or more fiducialmarkers are non-collinear.
 12. The method of claim 10, wherein the threeor more fiducial markers are sensor-coils placed on the patient's skin.13. The method of claim 1, wherein the endovascular percutaneous medicalprocedure comprises an aneurism repair procedure, a stentgrafting/placement procedure, a catheterization procedure, a filterplacement procedure, an angioplasty procedure, a minimally-invasivecatheter procedure, an ablation procedure, a cryoablation procedure, ora guidewire placement procedure.
 14. The method of claim 1, wherein theguidance comprises visual feedback or auditory feedback related tolocation and orientation of the physical interventional device.
 15. Themethod of claim 14, further comprising providing the visual feedback tomonitor when a graphic corresponding to the guidance control graphicsintersects a graphic corresponding to the reference graphics indicatingthat the physical interventional device is in alignment with atrajectory that would place the physical interventional device at atarget within the patient's vasculature.
 16. The method of claim 15,wherein the visual feedback includes a holographic annotation thatreports the distance or angle deviation from a targeted position ororientation.
 17. A head-mounted device comprising: a non-transitorymemory storing instructions; and a processor to access thenon-transitory memory and execute the instructions to: receive trackingdata for a physical interventional device in a tracking coordinatesystem, wherein the physical interventional device is used during anendovascular percutaneous medical procedure; transform the tracking datafor the physical interventional device in the tracking coordinate systeminto a headset coordinate system; access image data from a pre-operativeimage of a patient's anatomy comprising a physical operative site in animaging coordinate system; transform the image data in the imagingcoordinate system into the headset coordinate system; register a 3Dholographic representation of the interventional device based on thetracking data for the physical interventional device in the headsetcoordinate system to 3D anatomical holographic projections of thepatient's anatomy based on the imaging data in the headset coordinatesystem; display the 3D anatomical holographic projections providing avisualization of a holographic version of the patient's anatomy withreference graphics related to a physical operative site within thepatient's anatomy; displaying, by the head mounted device, the 3Dholographic representation of the interventional device providing avisualization of a holographic version of the interventional device withguidance control graphics related to the physical interventional device;and navigate the 3D holographic representation of the interventionaldevice in the 3D anatomical holographic projections based on thetracking data for the interventional device in the headset coordinatesystem, wherein the reference graphics and the guidance control graphicsprovide guidance for tracking the physical interventional device throughthe patient's anatomy using the 3D anatomical holographic projectionsand the 3D holographic representation of the interventional device. 18.The head-mounted device of claim 17, further comprising a head mounteddisplay to display the visualization.
 19. The head-mounted device ofclaim 18, wherein the processor further executes the instructions totransform the visualization by at least one of translating, rotating,and scaling to enhance the navigating triggered by a physical movementof the head mounted device.
 20. The head-mounted device of claim 17,wherein the transforming further comprises: locating positions of threeor more fiducial markers on the physical patient's skin, wherein thepositions are in the tracking coordinate system, wherein the positionsare non-collinear; and matching the positions of the three or morefiducial markers to three or more locations in the image data in theimage coordinate system.